ectopic preg

Question 1

what is an ectopic pregnancy?

Answer 1

implantation outside the uterine cavity
mc- fallopian tube

Question 2

At what week are ectopic pregnancies most commonly found?

Answer 2

around 8 weeks

Question 3

how common are ectopic pregnancies?

Answer 3

11/1000 births
2-3% incidence

Question 4

what are the risk factors for ectopic pregnancies?

Answer 4

PID- pelvic inflammatory disease, IVF, ENDOMETRIOSIS, IUS/IUD ( contraception) and a pmHx of ectopic pregnancies

Question 5

what are the symptoms for ectopic pregnancies?

Answer 5

• unilateral RIF/LIF pain
• light brown pV bleed
• dyschezia/dysuria
• n + v
• shock
• kehr sign - referred pain in L shoulder
• cervical motion tenderness ( less specific than PID) ( Excitation)

Question 6

how is ectopic preganncy diagnosed

Answer 6

serial BHCG increase by < 63%
trans vaginal ultrasound- visualises extrauterine pregnancy

Question 7

what is the treatment for ectopic pregnancy when expectant ?

Answer 7

Follow up needs to be possible to ensure successful termination
The ectopic needs to be unruptured
Adnexal mass < 35mm
No visible heartbeat
No significant pain
HCG level < 1500 IU / l

Question 8

what is the treatment for ectopic pregnancy when medical ?

Answer 8

IM methotrexate
same as expectant tx but:
HCG level must be < 5000 IU / l
Confirmed absence of intrauterine pregnancy on ultrasound

Question 9

when is the treatment for ectopic pregnancy when surgical ?

Answer 9

Pain
Adnexal mass > 35mm
Visible heartbeat
HCG levels > 5000 IU / l

salpingectomy- no fertility concern w/ oopherectomy ( the removal of one or both falopion tubes with the removal of one or both ovaries)

Question 10

if there is a rupture in an ectopic pregnancy, what do you do?

Answer 10

1. ABCDE
2. NBM
3. GROUP AND SAVE
4. ANTI D IMMMUNOGLOBIN IF WOMAN IS RH-

Question 11

what are the chances of recurrence in ectopic pregnancy?

Answer 11

18.5% recurrence
fallopian tube rupture

Question 12

what are complications of ectopic pregnancies?

Answer 12

fallopian tube rupture
early maternal death 2’ to shock
infertility with surgery